Improving outcomes for people with skin tumours including melanoma

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Improving Outcomes for People with Skin Tumours including Melanoma Organisation of skin cancer services • Ensure that referring GPs are given prompt and full information about their patients’ diagnosis or treatment in line with national standards on communication to GPs of cancer diagnoses. • Collect data for network-wide audit. Management of patients presenting in primary care The NICE Referral guidelines for suspected cancer 34 recommendations for skin cancer should be followed. These primarily relate to referral to a specialist in secondary care from a non-specialist GP. 3 Clinical guidelines have been published by the BAD and NICE for management of NMSC and by the BAD, British Association of Plastic Surgeons, Melanoma Study Group and NICE for the management of MM. 35,36,37,38 The recommendations for management of specific tumour types in primary care are summarised in Figure 14 in the ‘Initial investigation, diagnosis, staging and management’ chapter and are consistent with these clinical guidelines. These clinical guidelines have also been included within the Evidence Review. Structure and clinical governance All clinicians who see and plan to treat patients with skin cancer in the community should be approved by, and be accountable to, the LSMDT lead clinician, and work to agreed protocols. The work carried out should be audited on a regular basis and staff and resources made available for this. The LSMDT/SSMDT should be responsible for how these audits are organised and carried out. All doctors and nurses should have regular CPD and would be expected to attend the LSMDT/SSMDT meetings whenever one of their patients is being discussed, and at least four times a year. In addition, meetings to discuss audit results, guidelines and cancer measures should be arranged twice a year and all team members should attend these at least once year. 34 National Institute for Health and Clinical Excellence. Referral guidelines for suspected cancer. Available from: www.nice.org.uk/CG027 35 British Association of Dermatologists (1999) Guidelines for the management of basal cell carcinoma. Available from: www.bad.org.uk/healthcare/guidelines 36 British Association of Dermatologists (2002) Multiprofessional guidelines for the management of the patient with primary cutaneous squamous cell carcinoma. Available from: www.bad.org.uk/healthcare/guidelines 37 British Association of Dermatologists (2002) UK guidelines for the management of cutaneous melanoma. Available from: www.bad.org.uk/healthcare/guidelines 38 National Institute for Health and Clinical Excellence. Referral guidelines for suspected cancer. Available from: www.nice.org.uk/CG027 66 National Institute for Health and Clinical Excellence
B. Anticipated benefits At present, the service for patients with skin cancer is fragmented. Many patients are managed by GPs or a range of hospital practitioners who do not have a special interest in skin cancer. Consolidation of care into the hands of trained personnel working within approved structures and to network-wide evidence-based clinical protocols, who subject their work to audit, should ensure that every patient receives appropriate treatment. Improving Outcomes for People with Skin Tumours including Melanoma Organisation of skin cancer services All patients should be treated by teams whose resources and expertise are matched to the level the patients need. In some areas there may be a reduced use of hospital clinics for precancerous lesions and low-risk skin cancers. Patients with low-risk lesions may be managed closer to their homes. 3 There will be more time and resources created for the appropriate management of high-risk cases by the specialist teams. There will be greater standardisation of expertise and care across the cancer network. Multidisciplinary working ensures that interventions optimise the benefit to individual patients by drawing on numerous specialisations and hence a range of viewpoints. The MDT approach is valuable in terms of support and joint learning. The inclusion of palliative care specialists, psychologists, counsellors and psychiatrists should ensure that patients’ needs are met early. An increase in the number of CNSs is anticipated to reduce patient anxiety, enhance quality of life and avoid re-admission to hospital after treatment by identifying and treating problems promptly. The CNS will have a key role in educating patients about skin selfexamination in future years. Patients are likely to have more opportunity to communicate at length with the CNS, and the CNS can communicate patients’ psychosocial needs and wider concerns to all involved specialties. The CNS will also ensure continuity of care between hospital and community, and primary and palliative care. Management by efficiently coordinated MDTs, with adequate secretarial support and data management, will improve communication and coordination throughout the service. This will prevent duplication of work and help to ensure that all those involved in dealing with patients have the information they require to carry out their roles effectively. Guidance on cancer services: skin tumours including melanoma 67
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NHS National Institute for Health a
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Contents Improving Outcomes for Peo
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Patient information ...............
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Resource implications .............
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Foreword Improving Outcomes for Peo
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- referral - review of patient care
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early detection have been published
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The epidemiology of skin cancers an
Page 17 and 18: The incidence of MM increases with
Page 19 and 20: Figure 5. Mortality from MM, Englan
Page 21 and 22: Figure 8. Incidence of NMSC, Englan
Page 23 and 24: Risk factors for skin cancer As ski
Page 25 and 26: Figure 12. Rates of episodes of inp
Page 27 and 28: Two-week wait data Urgent skin canc
Page 29 and 30: • Improving the experience of car
Page 31 and 32: 12. National Institute for Clinical
Page 33 and 34: Patient-centred care Improving Outc
Page 35 and 36: This document and the NICE Referral
Page 37 and 38: A checklist may be used by healthca
Page 39 and 40: Quality assurance Surveys of patien
Page 41 and 42: One cross-sectional study found tha
Page 43 and 44: One RCT conducted with patients wit
Page 45 and 46: • Every skin cancer MDT having ac
Page 47 and 48: to estimate a separate cost for ser
Page 49 and 50: department or they may be referred
Page 51 and 52: The 2-week waiting time standard an
Page 53 and 54: The local hospital skin cancer mult
Page 55 and 56: A function of the LSMDT is to audit
Page 57 and 58: • lymphoedema therapists • phar
Page 59 and 60: SSMDT meetings should be at least f
Page 61 and 62: As set out in the section on ‘Arr
Page 63 and 64: • Palliative care specialists. Si
Page 65 and 66: Videoconferencing and teleconferenc
Page 67: A basic knowledge of skin cancer hi
Page 71 and 72: One systematic review (of the abili
Page 73 and 74: One retrospective study compared pa
Page 75 and 76: • Critical incidents where treatm
Page 77 and 78: Network-wide protocols It is not po
Page 79 and 80: Initial investigation, diagnosis, s
Page 81 and 82: Figure 14. Skin lesion - patient pa
Page 83 and 84: curettage (as recommended in BAD gu
Page 85 and 86: Diclofenac 3% gel (Solaraze) is lic
Page 87 and 88: Histopathology services for skin ca
Page 89 and 90: Patients with anogenital Bowen’s
Page 91 and 92: B. Anticipated benefits Better-qual
Page 93 and 94: One RCT compared teledermatology wi
Page 95 and 96: One systematic review based upon 12
Page 97 and 98: Expert review evidence suggests tha
Page 99 and 100: Immunotherapy An RCT comparing allo
Page 101 and 102: • Adherence to treatment protocol
Page 103 and 104: F. Research priorities • Given th
Page 105 and 106: For patients with low-risk BCC or S
Page 107 and 108: Follow-up for patients after treatm
Page 109 and 110: C. Evidence Evidence exists that ea
Page 111 and 112: One observational study found that
Page 113 and 114: The written and photographic inform
Page 115 and 116: Genetic predisposition to MM may al
Page 117 and 118: patients with cutaneous lymphoma sh
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A. Recommendations Generic recommen
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Cutaneous lymphoma All patients sho
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Children and young people with skin
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Gorlin’s syndrome Two expert revi
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Process • Audit of adherence to p
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• Cutaneous lymphoma is so rare t
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Dermal and subcutaneous tumours Aty
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c) The guidance will also refer to
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4.2.2 Healthcare settings and servi
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Referral from the Department of Hea
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Table A1. Summary of service option
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For those cancer networks with part
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Appendix 4 How this guidance manual
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Appendix 5 People and organisations
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Professor Julia Newton-Bishop Mr Ba
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• Bristol South and West PCT •
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• Healthcare Commission • Help
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• Royal College of Surgeons of En
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Appendix 5.3 Researchers carrying o
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Appendix 5.4 Expert advisers to the
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Appendix 5.5 Report* commissioned t
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Appendix 6 Glossary of terms Improv
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Chemoprophylaxis The use of a drug
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Electrodesiccation A surgical metho
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Immunotherapy Treatment by stimulat
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Morbidity A diseased condition or s
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Prognosis A prediction of the likel
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Systemic therapy Treatment that rea
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KS LHB LSMDT MCC MDT MM MRI NCC-C N
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Improving outcomes for people with skin tumours including melanoma

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